Let's stand up for true personalisation

Until recently Martin Routledge led the Putting People First delivery programme at the Department of Health. He is now head of operations for In Control. Here he reflects on personalisation in policy and practice and considers the challenges and opportunities ahead

martin routledge 2In April I left the Department of Health after more than nine years developing and supporting the delivery of personalisation with colleagues inside and outside of government. Following twenty years working in the third sector and local government, my reason for going to work with central government was to try to help policy and delivery better reflect the aspirations of disabled people to control their own lives. Thanks to the efforts of many, what came to be called personalisation has now become policy - imperfect in many ways but there to be built upon.  But some are asking what now - what is the future for personalisation in an age of austerity?

My passionately held view is that we must now defend and extend true personalisation to avoid slipping backwards to a past (still present for too many) of acceptance of institutionalised service models which deny disabled and older people and their families the right to have control over their own lives. There are many perversions of self-direction out there - but where we see these we must not fall into the trap of blaming personalisation itself but rather work to show how it can be done properly and support people to acheive this.

We have now entered some really tough times for many people who use social care, their families and for those in councils and provider organisations who commission and deliver support. Many are seeing their support reduced, workers are losing their jobs. This is a time of real danger for people looking to take charge of their lives via control of the support they get. Sceptics argue either that personalisation can't happen when resources are tight or worse, that it has always been part of an agenda to provide cover for cuts - but let us remember where it comes from. Personalisation in social care is part of a wider shift in our society towards the full inclusion of all people. It is not a government invention. It emerged from the struggles of disabled and older people with support from allies working in public services. Three decades ago disabled people worked out how to achieve independence and avoid services that trap them in limited lives. The crowning glories of the movement that developed were the social model of disability and the 1990's legislation on direct payments.

Despite these key achievements people still had to fight to take charge within a service system which struggled to shift away from its institutional roots - frustrating the many great people working within it. People really needed an answering echo from policy and the social care system which hadn't been properly provided by the reforms of the 90s.

I am proud to have been in the room on a cold winter afternoon in Wigan in 2003 with Julie Stansfield and Steve Jones when In Control was born. The amazing team that then came together, including Simon Duffy, Helen Sanderson, Caroline Tomlinson, John Waters and Carl Poll, knew that they were standing on the shoulders of giants from the disability movement. The team knew that their job was not just to develop practical approaches to adapt the system to facilitate self-direction. It was also to find a way to get social care policy and practice to align with the goals of the independent living movement and those struggling for better lives for older people. Our heroes were people like Jane Campbell and Jenny Morris (I emailed Jenny on the publication of Life Chances for Disabled People to congratulate her and tell her I couldn't sleep with excitement!). These are the true roots of personalisation, not civil servants sitting in a room developing policy for others to implement - though to give them due credit several played a positive part and have continued to do so. This was one of those rare moments when policy people were looking for big ideas for public sector reform, a powerful approach had bubbled up from the real world of people's lives, and a crucial political consensus formed itself around it.

Following the testing of what became personal budgets alongside the further development of self-directed support by In Control and its local members, Ivan Lewis then minister for social care, saw through the development of Putting People First. This was a breakthrough moment in policy, providing a strong steer on delivery focusing on choice and control, early intervention, advice information and advocacy and social capital. It also provided £520m for initial implementation. Has all this funding been used well? Clearly in too many cases it has not. Have all councils, providers, professionals and people who use services fully embraced personalisation - certainly not. Might some things have been tackled differently - yes of course. But what did we expect? This is hard stuff - managing complex politics, working out the practical detail, engaging with understandable scepticism, changing well established practices, hardest of all - bringing people and organisations together locally to drive change. Despite these strong challenges much has happened - important lessons have been learned, strong foundations have been laid and most importantly lives have changed.

Others have recently and correctly noted the corruptions of personalisation now happening in too many places. In some we see crude cuts being justified in its name and restrictions on the use of personal budgets which make no financial sense but seriously hinder the opportunities for creativity and efficiency that personal budgets can offer. In others we see daft bureaucracy when what we need is simple lean process that let professionals do their jobs and people take control of their support. We also see places where the numbers are high but the positive changes low. As a result some people start to see personalisation as part of the problem facing older and disabled people rather than central to the solution. This is tragic but not surprising.

Recent commentators have also quite rightly stated that neither personal budgets nor even the broader elements of personalisation will be sufficient to achieve the transformation of society that many of us want to see. But let's be careful not to fall into the trap of the guy in the joke who, when asked for directions answers "well I wouldn't start from here". For example, if the option of shifting to a rights based benefits approach had been available in 2003 I personally would have snatched the government's hand off but it wasn't. If we could have made accessing the social care reform grant conditional on delivering real cultural and systems change or starting with those ready to do this ditto. Someone once said politics is the art of the possible - not being able to get everything we want isn't a good reason to fail to get those things we can if we work hard and skilfully, with allies.

So yes it is true we don't yet have perfect policy positions or all the resources we wish we had. That is neither a reason to despair nor to retreat from those things which when done properly, can transform real people's lives. Let us remember that the disabled pioneers and their allies in the 70s and 80s were also operating in tough times.

Let's not let weariness and understandable scepticism become cynicism. Let's keep helping people take control and make best use of their resources and support and keep encouraging commissioners and providers to make this increasingly possible. Let's take advantage of the policy position in the new vision for adult social care and developments such as personal health budgets, the Right to Control programme and the positive elements of the SEN green paper. The new Think Local Act Personal partnership brings together a strong and broad leadership coalition to help us maintain this momentum.

Through showing what is possible by doing personalisation right in as many places and situations as possible we can keep building the momentum for bigger and better change over time. Along the way we will grow the numbers of people working for true personalisation and the force they can exert. These driven and energetic people will be the allies and leaders of the future - disabled people, families and workers.

In the meantime most of the action, as always, will be at local level. Partners need to produce real time local evidence of impact of their delivery of personalisation and take learning about what is working and not working in order to adapt local efforts. The POET tool developed by John Waters and colleagues is now being used to do this and later in the spring we will report the first findings from online survey work sponsored by the former Putting People First consortium. Already almost 2000 personal budget holders and carers have reported on their experiences. This will mean that rather than rely on old research or time-lagging data with insufficient focus on outcomes, councils and local people will be able to see what is happening locally and benchmark with others. Without pre-empting the findings too much we expect them to show positive outcomes for people alongside important learning to guide improvement of delivery.

Use of this type of approach can facilitate practical local co-production with people who use social care alongside carers and their organisations. This co-production is another area at risk in tough financial times. Much progress over the past few years in the development of user-led organisations and in some places shifting from the sham of "user involvement" to real co-production must be sustained and extended not rolled back. It was encouraging that the DH prioritised guidance in this area alongside the social care vision and that the new Think Local, Act Personal Partnership has made co-production one of its key workstreams, but this must be reflected in continuing local support for real engagement at individual, operational and strategic levels.

One valid criticism of the early arrangements for implementing Putting People First was the insufficient engagement at all levels with the full range of provider organisations. The National Market Development forum has provided a useful place for identifying and initiating work across commissioners and providers which can help willing providers to adapt to and embrace increased choice and control for people using their services. There were encouraging suggestions in the social care vision and even recently in the budget, that some of the barriers faced by small local enterprises may be removed and the work of the micro-markets project, now taken forward by Community Catalysts and others provides practical approaches and assistance on this. A very welcome development is the strong representation of leading provider organisations and umbrella bodies in the new Think Local, Act Personal Partnership, which has prioritised supporting provider development in its new programme. The programme, to be launched in April, will include important products and learning from a national provider development programme led by Sam Bennett that has been taking learning about the personalisation of services and support from a wide range of providers and settings including residential care.

Supporting community contribution and mutual support is going to be crucial going forward and this is entirely complementary with the allocation of personal budgets to individuals as some ground breaking initiatives are starting to show. A recent Guardian dragons den style event and roundtable showcased some of the best local and national initiatives that have been identified by the Building Community Capacity programme led by Catherine Wilton. ADASS president Richard Jones was so impressed by the SPICE time-credits initiative for example, that he invited them to present to directors of social care at the ADASS spring seminar where they went down a storm. Such programmes are of course very vulnerable at this time. It was very encouraging in this context  to see the example of Leeds Neighbourhood Networks  present at the Guardian event - locally based voluntary-led projects supporting older people offered long term contracts by a council which knows the preventive effect they have. Evidence of this is critical at this time and the programme has been working closely with Professor Martin Knapp and colleagues at the School of Social Care Research who have already provided evidence of the cost effectiveness of time-banking and befriending programmes. Further work is underway and will be shared by the Think Local Act, Personal partnership.

Space doesn't allow me to talk about the importance and opportunities around advice and information, workforce development for personalisation or the person-centred approaches to re-ablement that, Helen Sanderson, Jenny Pitts and colleagues have recently described. These and other developing approaches from local efforts will all continue to be shared via the new Think Local, Act Personal website to be hosted by SCIE.

So as I move on to my own new roles I feel a mixture of trepidation and possibility and a determination to play my small part over the next few years in keeping personalisation real and  I'll be blogging regularly to share my thoughts and experiences.

Leave Comment

Last Updated : 27 April 2011. Page Author: Laura Bimpson.